Current Diabetes Reports

, 19:120 | Cite as

Subcutaneous Insulin Dosing Calculators for Inpatient Glucose Control

  • Jagdeesh UllalEmail author
  • Joseph A. Aloi
Health Care Delivery Systems and Implementation in Diabetes (ME McDonnell and AR Sadhu, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Health Care Delivery Systems and Implementation in Diabetes


Purpose of Review

The goal of this review is to summarize information about insulin dosing software and calculators used as computerized decision support systems or electronic glucose management systems (eGMS). These are used for hospitalized, insulin-treated patients with diabetes. We describe the advantages and disadvantages and the rationale for their use.

Recent Findings

We compared commercially available insulin dosing software, namely, Glucommander™, EndoTool®, GlucoStabilizer®, and GlucoTab®, in addition to computerized order entry systems that are available in electronic health records. The common feature among these eGMS is their ability to limit occurrences of hypoglycemia while achieving and maintaining patients at target blood glucose level.


More research needs to be done examining the efficacy of eGMS in disease-specific states and their benefits and utility in preventing adverse outcomes. Their long-term benefits to health care systems are beginning to emerge in cost-saving benefits and prevention of readmissions.


Electronic glucose management system Inpatient diabetes management Glucommander™ GlucoTab® GlucoStabilizer® EndoTool® 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict(s) of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(1):16–38.CrossRefGoogle Scholar
  2. 2.
    • Aloi J, Bode BW, Ullal J, Chidester P, McFarland RS, Bedingfield AE, et al. Comparison of an electronic glycemic management system versus provider-managed subcutaneous basal bolus insulin therapy in the hospital setting. J Diabetes Sci Technol. 2017;11(1):12–6 This paper demonstrates the use and utility of eGMS compared with basal-bolus insulin therapy. CrossRefGoogle Scholar
  3. 3.
    Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care. 2009;32(6):1119–31.CrossRefGoogle Scholar
  4. 4.
    Mulla CM, Lieb DC, McFarland R, Aloi JA. Tides of change: improving glucometrics in a large multihospital health care system. J Diabetes Sci Technol. 2015;9(3):602–8.CrossRefGoogle Scholar
  5. 5.
    Aloi JA, Mulla C, Ullal J, Lieb DC. Improvement in inpatient glycemic care: pathways to quality. Curr Diab Rep. 2015;15(4):18.CrossRefGoogle Scholar
  6. 6.
    Umpierrez GE, Smiley D, Jacobs S, Peng L, Temponi A, Mulligan P, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diabetes Care. 2011;34(2):256–61.CrossRefGoogle Scholar
  7. 7.
    Umpierrez GE, Smiley D, Zisman A, Prieto LM, Palacio A, Ceron M, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Diabetes Care. 2007;30(9):2181–6.CrossRefGoogle Scholar
  8. 8.
    Brand DA, Peragallo-Dittko V, Fazzari MJ, Islam S, Jacobson AM, Radin MS. Changing to basal-bolus insulin therapy for the inpatient management of hyperglycemia-a natural experiment. Endocr Pract. 2019;25:836–45.CrossRefGoogle Scholar
  9. 9.
    van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345(19):1359–67.CrossRefGoogle Scholar
  10. 10.
    Griesdale DE, de Souza RJ, van Dam RM, Heyland DK, Cook DJ, Malhotra A, et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ. 2009;180(8):821–7.CrossRefGoogle Scholar
  11. 11.
    Colunga-Lozano LE, Gonzalez Torres FJ, Delgado-Figueroa N, Gonzalez-Padilla DA, Hernandez AV, Roman Y, et al. Sliding scale insulin for non-critically ill hospitalised adults with diabetes mellitus. Cochrane Database Syst Rev. 2018;11:CD011296.PubMedGoogle Scholar
  12. 12.
    Basal-Bolus Versus sliding-scale insulin therapy in the acute care hospital setting: a review of comparative clinical effectiveness and cost-effectiveness. CADTH Rapid Response Reports Ottawa (ON), 2017.Google Scholar
  13. 13.
    American Diabetes A. Diabetes care in the hospital. Diabetes Care. 2016;39(Suppl 1):S99–104.Google Scholar
  14. 14.
    Schroeder JE, Liebergall M, Raz I, Egleston R, Ben Sussan G, Peyser A, et al. Benefits of a simple glycaemic protocol in an orthopaedic surgery ward: a randomized prospective study. Diabetes Metab Res Rev. 2012;28(1):71–5.CrossRefGoogle Scholar
  15. 15.
    Colibaseanu DT, Osagiede O, McCoy RG, Spaulding AC, Habermann EB, Naessens JM, et al. Proactive protocol-based management of hyperglycemia and diabetes in colorectal surgery patients. Endocr Pract. 2018;24(12):1073–85.CrossRefGoogle Scholar
  16. 16.
    Rushakoff RJ, Sullivan MM, Seley JJ, Sadhu A, O’Malley CW, Manchester C, et al. Using a mentoring approach to implement an inpatient glycemic control program in United States hospitals. Healthc (Amst). 2014;2(3):205–10.CrossRefGoogle Scholar
  17. 17.
    Maynard G, Schnipper JL, Messler J, Ramos P, Kulasa K, Nolan A, et al. Design and implementation of a web-based reporting and benchmarking center for inpatient glucometrics. J Diabetes Sci Technol. 2014;8(4):630–40.CrossRefGoogle Scholar
  18. 18.
    Certification in inpatient diabetes the world wide web: the joint commission; 2019 [Available from: Accessed 06 June 2019
  19. 19.
    Goldberg PA, Bozzo JE, Thomas PG, Mesmer MM, Sakharova OV, Radford MJ, et al. “Glucometrics”--assessing the quality of inpatient glucose management. Diabetes Technol Ther. 2006;8(5):560–9.CrossRefGoogle Scholar
  20. 20.
    American Diabetes A. 15. Diabetes care in the hospital: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S173–S81.CrossRefGoogle Scholar
  21. 21.
    Draznin B, Gilden J, Golden SH, Inzucchi SE, investigators P, Baldwin D, et al. Pathways to quality inpatient management of hyperglycemia and diabetes: a call to action. Diabetes Care. 2013;36(7):1807–14.CrossRefGoogle Scholar
  22. 22.
    Alamri N, Seley JJ. Evaluation of several electronic glycemic management systems. J Diabetes Sci Technol. 2018;12(1):60–2.CrossRefGoogle Scholar
  23. 23.
    Ateya MB, Aiyagari R, Moran C, Singer K. Insulin bolus calculator in a pediatric hospital. Safety and user perceptions. Appl Clin Inform. 2017;8(2):529–40.CrossRefGoogle Scholar
  24. 24.
    Mathioudakis N, Jeun R, Godwin G, Perschke A, Yalamanchi S, Everett E, et al. Development and implementation of a subcutaneous insulin clinical decision support tool for hospitalized patients. J Diabetes Sci Technol. 2019;13(3):522–32.CrossRefGoogle Scholar
  25. 25.
    Decision support in Epic helps reduce insulin dosing errors by 50% Epic Systems Corporation; November 13, 2017 [Available from:
  26. 26.
    Gianchandani R, Umpierrez GE. Inpatient use of computer-guided insulin devices moving into the non-intensive care unit setting. Diabetes Technol Ther. 2015;17(10):673–5.CrossRefGoogle Scholar
  27. 27.
    Mabrey ME, McFarland R, Young SL, Cooper PL, Chidester P, Rhinehart AS. Effectively identifying the inpatient with hyperglycemia to increase patient care and lower costs. Hosp Pract (1995). 2014;42(2):7–13.CrossRefGoogle Scholar
  28. 28.
    • Newsom R, Patty C, Camarena E, Sawyer R, McFarland R, Gray T, et al. Safely converting an entire academic medical center from sliding scale to basal bolus insulin via implementation of the eGlycemic management system. J Diabetes Sci Technol. 2018;12(1):53–9 This paper illustrates the steps that can be taken to initiate eGMS in an institution and utlity and benefits of implementing electronic glucose management. CrossRefGoogle Scholar
  29. 29.
    Mumpower A, Parsons T, McFarland RA, Henderson A, editors. Does glycemic control using eGMS reduce readmission rates for hospitalized patients undergoing CABG? Annual Diabetes Technology Meeting, Bethesda, MD, 2017Google Scholar
  30. 30.
    Aloi J, Ullal J, Chidester P, McFarland R. “AUTO study” AUtomatic titration tO target: subcutaneous basal bolus insulin management using eGMS in the non-ICU setting. American Association of Clinical Endocrinologists (AACE) Annual Scientific & Clinical Congress; Austin, TX: Endocr Pract; 2017. p. 1–326.Google Scholar
  31. 31.
    Aloi J, Chidester P, Henderson A, Booth R, McFarland R, Mumford A, et al., editors. Improved inpatient hypoglycemia rates with electronic glycemic management system. American Association of Clinical Endocrinologists (AACE) Annual Scientific & Clinical Congress; May 2016; Orlando, FL: Endocrine Practice.Google Scholar
  32. 32.
    Juneja R, Golas AA, Carroll J, Nelson D, Abad VJ, Roudebush CP, et al. Safety and effectiveness of a computerized subcutaneous insulin program to treat inpatient hyperglycemia. J Diabetes Sci Technol. 2008;2(3):384–91.CrossRefGoogle Scholar
  33. 33.
    Tanenberg RJ, Hardee S, Rothermel C, Drake AJ 3rd. Use of a computer-guided glucose management system to improve glycemic control and address national quality measures: a 7-year, retrospective observational study at a tertiary care teaching hospital. Endocr Pract. 2017;23(3):331–41.CrossRefGoogle Scholar
  34. 34.
    Donsa K, Beck P, Holl B, Mader JK, Schaupp L, Plank J, et al. Impact of errors in paper-based and computerized diabetes management with decision support for hospitalized patients with type 2 diabetes. A post-hoc analysis of a before and after study. Int J Med Inform. 2016;90:58–67.CrossRefGoogle Scholar
  35. 35.
    Spat S, Donsa K, Beck P, Holl B, Mader JK, Schaupp L, et al. A mobile computerized decision support system to prevent hypoglycemia in hospitalized patients with type 2 diabetes mellitus. J Diabetes Sci Technol. 2017;11(1):20–8.CrossRefGoogle Scholar
  36. 36.
    Bode B, Harrison C (eds). Time to target using eGMS to manage inpatient subcutaneous insulin basal bolus regimen. International Conference on Advanced Technologies & Treatments for Diabetes; February 2017. Diabetes Technology & Therapeutics: Mary Ann Liebert Inc., PublishersGoogle Scholar
  37. 37.
    Hulkower RD, Pollack RM, Zonszein J. Understanding hypoglycemia in hospitalized patients. Diabetes Manag (Lond). 2014;4(2):165–76.CrossRefGoogle Scholar
  38. 38.
    Ullal J, Mabrey M, Henderson A, McFarland R, Booth R, Aloi J. eGlycemic management system provides safe and effective glycemic control for stroke patients requiring subcutaneous insulin in the hospital setting. Annual Diabetes Technology Meeting; Bethesda, MD, 2015.Google Scholar
  39. 39.
    Moxey A, Robertson J, Newby D, Hains I, Williamson M, Pearson SA. Computerized clinical decision support for prescribing: provision does not guarantee uptake. J Am Med Inform Assoc. 2010;17(1):25–33.CrossRefGoogle Scholar
  40. 40.
    Pearson SA, Moxey A, Robertson J, Hains I, Williamson M, Reeve J, et al. Do computerised clinical decision support systems for prescribing change practice? A systematic review of the literature (1990-2007). BMC Health Serv Res. 2009;9:154.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Center for Diabetes and Endocrinology, Division of Endocrinology, Department of MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Department of Internal Medicine, Section on Endocrinology and MetabolismWake Forest School of MedicineWinston-SalemUSA

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